Ansari F., Goossens H., Davey on behalf of the ESAC II HC Subproject Working Group P.

Objectives: The ESAC I project demonstrated the lack of unified hospital information on antibiotic use and standardised denominator of clinical activity across Europe. In 2004 DG SANCO supported the ESAC II Hospital Care subproject to improve the knowledge of antibiotic consumption, to consolidate the continuous collection of comprehensive data, to develop and validate health indicators based on antibiotic consumption data, and to use a set of core indicators to provide feedback to the participating countries. The ESAC II HC subproject consists of Longitudinal Survey and Point Prevalence Survey. By the end of the project we wish to produce standardised data from at least one hospital per country and to develop a strategy for regional and national roll outs. The main objective of longitudinal survey is to establish a platform for statistical analysis of time trends within and between the hospitals and countries and to compare results using bed days or admissions as denominators.

Methods: Monthly data were collected from each hospital for a 6-year period from 2000 for antibacterials dispensed to inpatient destinations in DDD as numerator, and bed days and admissions as denominators. Databases were assigned for ATC/DDD and analysed centrally in Dundee. Statistical analysis was conducted using regression modelling of time series.

Results: We have analysed longitudinal data from 14 hospitals so far. In 11 hospitals the direction of time trends was the same using bed-days or admissions (increasing in 8 which were significant for 3, decreasing in 3). In the 3 remaining hospitals the trends were different; DDD/100 bed days showed increase over time whereas DDD/100 admissions showed a decrease. In 3 hospitals there was significant increase over time in DDD/100 bed days whereas there was a non-significant increase in DDD/100 admissions. The proportion of parenteral antibacterials used in 15 hospitals in 2005 was 878% and the rank order of parenteral use was very different from total use.

Conclusion: The results show similar significant trends with the 2 denominators in 6 of the 14 hospitals. Using additional denominators of clinical activity especially in longitudinal studies could provide set of indicators of prescribing quality and resource use. Including prescription at discharge in some hospitals might explain differences in use of parenteral antibacterials from total use.

Parenteral use might be a more meaningful indicator of inpatient treatment than total use.